C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 433—STATE FISCAL ADMINISTRATION › Subpart F—Refunding of Federal Share of Medicaid Overpayments to Providers

42 C.F.R. § 433.300

Basis

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This subpart implements—

(a) Section 1903(d)(2)(A) of the Act, which directs that quarterly Federal payments to the States under title XIX (Medicaid) of the Act are to be reduced or increased to make adjustment for prior overpayments or underpayments that the Secretary determines have been made.

(b) Section 1903(d)(2)(C) and (D) of the Act, which provides that a State has 1 year from discovery of an overpayment for Medicaid services to recover or attempt to recover the overpayment from the provider before adjustment in the Federal Medicaid payment to the State is made; and that adjustment will be made at the end of the 1-year period, whether or not recovery is made, unless the State is unable to recover from a provider because the overpayment is a debt that has been discharged in bankruptcy or is otherwise uncollectable.

(c) Section 1903(d)(3) of the Act, which provides that the Secretary will consider the pro rata Federal share of the net amount recovered by a State during any quarter to be an overpayment.

[54 FR 5460, Feb. 3, 1989, as amended at 77 FR 31511, May 29, 2012]
Notes of Decisions
Cited in 5 cases, 2003–2019 · leading case: United States v. Emor, 850 F. Supp. 2d 176 (D.D.C. 2012).
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United States v. Emor, 850 F. Supp. 2d 176 (D.D.C. 2012). · cites it 2× “In response to the Court’s inquiry about the apportionment of any restitution award between the District of Columbia and federal governments, the government represented that pursuant to 42 C.F.R. § 433.300 et seq., the District of Columbia may be required to refund the federal…”
Finnerty v. Thornton Hall, Inc., 593 S.E.2d 568 (Va. Ct. App. 2004). “; 42 C.F.R. § 433.300 et seq. Though they mention various stages of the reimbursement process, neither the federal nor the state regulations define the expression “initial determination,” determine its timing, or provide any specific procedures unique to it.”
Psychiatric Healthcare Corp. v. Dep't of Soc. Servs., 100 S.W.3d 891 (Mo. Ct. App. 2003). “107 , governing agreements between the State and the service providers; 42 CFR § 433.300 , mandating recovery of overpayments for Medicaid services; 42 CFR § 482.”
Lee Mem'l Health Sys. etc. v. State of Florida, Agency For Agency For Health etc., 272 So. 3d 431 (Fla. 1st DCA 2019). “42 C.F.R. § 433.300 . The U.S. government pays federal financial participation (“FFP”) to participating states on a quarterly basis.”
Kathleen Papa v. DHS (Wis. Ct. App. 2019). “Wisconsin’s Medicaid program is subject to federal audits, which ensure the state is recovering improper payments and refunding the federal share to the Centers for Medicare and Medicaid Services (CMS).”
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